The article below is a top story from this week's ACTION newsletter—Care Providers of Minnesota's weekly newsletter for members. The newsletter focuses on current legislative issues, regulations, long-term care trends, and other Association news. Each Thursday evening, it is delivered to your inbox. To sign up for ACTION, contact Lisa Foss Olson (952-851-2483). To learn more about membership, visit our Become a Member page.


MDH case mix classification system experiencing difficulties

Todd Bergstrom
By Todd Bergstrom  |  October 18, 2019  |  SNF/NF providers

The Minnesota Department of Health (MDH) computer program that generates the Medicaid case mix classification (or RUG level) to be used by the Minnesota Department of Human Services (DHS) for Medicaid payment, as well as populate resident classification letter, is experiencing technical difficulties.

Note the Minnesota Department of Health (MDH) is successfully accepting the Minimum Data Set (MDS) files transmitted by nursing facilities. The issue lies within the MDH “RUG Calculator.” MDH is first working to assure the accuracy of the RUG classifications that are generated and sent over to DHS for payment to nursing facilities.

According to MDH communication:
The October 1, 2019, updates by CMS have impacted the MDH Case Mix Review Program. Please share this information with facility administrator, MDS coordinator, CMR portal users, and other facility staff as needed.
  • Due to the software updates by the Centers for Medicare & Medicaid Services (CMS), MDH case mix review will NOT PENALIZE OBRA assessments submitted and accepted by QIES ASAP from October1, 2019, through October 31, 2019
  • RUGs calculations: Some of the OBRA assessments submitted to QIES ASAP and copied by MDH case mix review are not calculating a RUG classification (i.e. Medicaid RUG-IV 48 Grouper)
    • These assessments will appear in Section 2 on the case mix validation report
    • No action is required by facility staff
    • MDH case mix review has a plan and will share RUGS classification and effective dates with the DHS for Medicaid payments
    • MDH case mix review IT staff are working on this issue and expect to resolve by the week of October 21
  • Minnesota statute requires the nursing facility to distribute the “notice of resident reimbursement classification” within three business days of receipt of the notices (not three days from when the notices were expected to be in the MDH case mix review portal).

Please contact Todd Bergstrom at the Association office if you have any questions.

Todd Bergstrom  |  Director of Research & Data Analysis  |  |  952-851-2486

About Care Providers of Minnesota

Care Providers of Minnesota is a non-profit membership association with the mission to Empower Members to Performance Excellence. Our 900+ members across Minnesota represent non-profit and for-profit organizations providing services along the full spectrum of post-acute care and long-term services and support. We are the state affiliate for the American Health Care Association/National Center for Assisted Living, and with our national partners we provide solutions for quality care.

Learn more

Become a Member

As a member of Care Providers of Minnesota, you will join with fellow professionals across the state who understand the importance of working together to the benefit of the entire long-term care profession. The strength of our membership has established our place as one of the state’s leading trade associations.

Learn more